Liver disease

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Hepatic impairment
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Liver disease
Other namesHepatic disease
liver metastases caused by pancreatic cancer
SpecialtyHepatology, gastroenterology
TypesFatty liver disease, Hepatitis (and several more)[1]
Diagnostic methodLiver function tests[2]
TreatmentDepends on type(See types)

Liver disease, or hepatic disease, is any of many diseases of the liver.[1] If long-lasting it is termed chronic liver disease.[3] Although the diseases differ in detail, liver diseases often have features in common.

Liver diseases

  • Ground glass hepatocytes
    Ground glass hepatocytes
  • Primary biliary cirrhosis
    Primary biliary cirrhosis
  • Budd–Chiari syndrome
    Budd–Chiari syndrome
  • Micrograph of non-alcoholic fatty liver disease
    non-alcoholic fatty liver disease

There are more than a hundred different liver diseases. Some of the most common are:[4]

Signs and symptoms

Some of the signs and symptoms of a liver disease are the following:

Mechanisms

Liver diseases can develop through several mechanisms:

DNA damage

One general mechanism, increased

Viral infection by hepatitis B virus, or hepatitis C virus causes an increase of

TP53, is mutated in more than 20% of liver cancers while 41 genes each have hypermethylated promoters (repressing gene expression) in more than 20% of liver cancers.[30]

Alcohol consumption in excess causes a build-up of acetaldehyde. Acetaldehyde and free radicals generated by metabolizing alcohol induce DNA damage and oxidative stress.[31][32][33] In addition, activation of neutrophils in alcoholic liver disease contributes to the pathogenesis of hepatocellular damage by releasing reactive oxygen species (which can damage DNA).[34] The level of oxidative stress and acetaldehyde-induced DNA adducts due to alcohol consumption does not appear sufficient to cause increased mutagenesis.[34] However, as reviewed by Nishida et al.,[28] alcohol exposure, causing oxidative DNA damage (which is repairable), can result in epigenetic alterations at the sites of DNA repair. Alcohol-induced epigenetic alterations of gene expression appear to lead to liver injury and ultimately carcinoma.[35]

Obesity is associated with a higher risk of primary liver cancer.[36] As shown with mice, obese mice are prone to liver cancer, likely due to two factors. Obese mice have increased pro-inflammatory cytokines. Obese mice also have higher levels of deoxycholic acid, a product of bile acid alteration by certain gut microbes, and these microbes are increased with obesity. The excess deoxycholic acid causes DNA damage and inflammation in the liver, which, in turn, can lead to liver cancer.[37]

Other relevant aspects

Several liver diseases are due to viral infection.

Single cell sequencing and kinome profiling [45]

Air pollutants

Particulate matter or carbon black are common pollutants. They have a direct toxic effect on the liver; cause inflammation of liver caused by and thereby impact lipid metabolism and fatty liver disease; and can translocate from the lungs to the liver.[46]

Because particulate matter and carbon black are very diverse and each has different toxicodynamics, detailed mechanisms of translocation are not clear. Water-soluble fractions of particulate matter are the most important part of translocation to the liver, through extrapulmonary circulation. When particulate matter gets into the bloodstream, it combines with immune cells and stimulates innate immune responses.

Pro-inflammatory cytokines are released and cause disease progression.[46]

Diagnosis

A number of

Imaging tests such as

ultrasound and magnetic resonance imaging can be used to show the liver tissue and the bile ducts. Liver biopsy can be performed to examine liver tissue to distinguish between various conditions; tests such as elastography may reduce the need for biopsy in some situations.[47]

In liver disease,

hepatic clearance and compensatory productions from other sites of the body.[48] Fibrinolysis generally proceeds faster with acute liver failure and advanced stage liver disease, unlike chronic liver disease in which concentration of fibrinogen remains unchanged.[48]

A previously undiagnosed liver disease may become evident first after autopsy.[citation needed] Following are gross pathology images:

Treatment

Ursodeoxycholic acid

Anti-viral medications are available to treat infections such as hepatitis B.[49] Other conditions may be managed by slowing down disease progression, for example:

  • By using steroid-based drugs in autoimmune hepatitis.[50]
  • Regularly removing a quantity of blood from a vein (venesection) in the iron overload condition,
    hemochromatosis.[51]
  • Wilson's disease, a condition where copper builds up in the body, can be managed with drugs that bind copper, allowing it to be passed from the body in urine.[52]
  • In cholestatic liver disease, (where the flow of bile is affected due to cystic fibrosis[53]) a medication called ursodeoxycholic acid may be given.[54]

See also

  • Model for end-stage liver disease
    (MELD)

References

  1. ^ a b "Liver Diseases". MedlinePlus.
  2. ^ a b MedlinePlus Encyclopedia: Liver function tests
  3. ^ "NHS Choices". Cirrhosis. Retrieved 6 October 2015.
  4. ^ "Liver disease – NHS Choices". www.nhs.uk. Retrieved 2015-06-20.
  5. ^ "CDC – Fasciola". www.cdc.gov. Retrieved 2015-06-20.
  6. ^ "Hepatitis". MedlinePlus.
  7. ^ MedlinePlus Encyclopedia: Alcoholic liver disease
  8. ^ "Hepatic steatosis". Retrieved 2015-06-20.
  9. ^ "Non-alcoholic fatty liver disease – NHS Choices". www.nhs.uk. Retrieved 2015-06-20.
  10. ^ "Hemochromatosis". MedlinePlus.
  11. ^ "Alpha-1 Antitrypsin Deficiency". MedlinePlus.
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  13. ^ "Transthyretin amyloidosis". Genetics Home Reference. Retrieved 2015-06-20.
  14. ^ "Gilbert syndrome". Genetics Home Reference. Retrieved 2015-06-20.
  15. ^ "Cirrhosis: MedlinePlus Medical Encyclopedia". www.nlm.nih.gov. Retrieved 2015-06-20.
  16. ^ "Liver cancer – Hepatocellular carcinoma: MedlinePlus Medical Encyclopedia". www.nlm.nih.gov. Retrieved 2015-06-20.
  17. ^ "Primary biliary cirrhosis: MedlinePlus Medical Encyclopedia". www.nlm.nih.gov. Retrieved 2015-06-20.
  18. ^ "Sclerosing cholangitis: MedlinePlus Medical Encyclopedia". www.nlm.nih.gov. Retrieved 2015-06-20.
  19. ^ "Hepatic vein obstruction (Budd-Chiari): MedlinePlus Medical Encyclopedia". www.nlm.nih.gov. Retrieved 2015-06-20.
  20. ^ "Liver Disease | NIDDK". National Institute of Diabetes and Digestive and Kidney Diseases. Retrieved 2021-11-30.
  21. ^ "Alcoholic Liver Disease". The Lecturio Medical Concept Library. Retrieved 27 June 2021.
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  24. ^ "Chronic Liver Disease/Cirrhosis | Johns Hopkins Medicine Health Library". 12 April 2022.
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  33. ^ "Drinking alcohol causes cancer by 'damaging DNA' - Independent.ie". 5 January 2018.
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  36. PMID 27909908. {{cite book}}: |journal= ignored (help
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  38. PMID 25083074.{{cite journal}}: CS1 maint: DOI inactive as of January 2024 (link
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  39. ^ "Hepatitis B and C: ways to promote and offer testing to people at increased risk of infection | Guidance and guidelines | NICE". www.nice.org.uk. 12 December 2012. Retrieved 2015-06-24.
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  50. ^ "Phlebotomy Treatment | Treatment and Management | Training & Education | Hemochromatosis (Iron Storage Disease) | NCBDDD | CDC". www.cdc.gov. Retrieved 2015-06-20.
  51. ^ "Wilson Disease". www.niddk.nih.gov. Archived from the original on 2015-06-21. Retrieved 2015-06-20.
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Further reading

External links